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目的探讨肺功能不全食管癌患者围手术期的治疗措施,总结治疗经验。方法回顾性分析武钢总医院2001年1月至2009年1月手术治疗76例肺功能不全食管癌患者的临床资料,其中男52例,女24例;年龄49~80岁,平均年龄62.5岁。术前经戒烟、预防和控制呼吸道感染、呼吸道雾化吸入或应用解痉化痰药物,呼吸功能锻炼和氧疗以改善肺功能。行左后外侧切口食管癌根治术26例,右胸前外侧切口、上腹部正中切口手术(Ivorlewis术式)33例,颈、胸、腹三切口手术17例,术后施行静脉自控镇痛(PCIA)、抗感染、解痉化痰、保持呼吸道通畅、营养支持和氧疗;部分患者予以呼吸支持。结果全组76例中,19例术后行机械通气支持,术后发生肺部并发症9例,心律失常5例,颈部吻合口漏1例;无围术期死亡,所有患者均痊愈出院。术后均获得随访,随访时间3~6个月,均恢复良好,无手术相关并发症。结论严谨的围手术期处理和肺保护是肺功能不全食管癌患者手术成功的重要因素。
Objective To investigate the perioperative management of esophageal cancer patients with pulmonary insufficiency and to summarize the experience of treatment. Methods The clinical data of 76 patients with esophageal lung dysfunction who underwent surgical treatment from January 2001 to January 2009 in WISCO General Hospital were retrospectively analyzed. There were 52 males and 24 females, aged from 49 to 80 years with a mean age of 62.5 years. Preoperative smoking cessation, prevention and control of respiratory infections, respiratory inhalation or application of antispasmodic phlegm drugs, respiratory functional exercise and oxygen therapy to improve lung function. Twenty-six cases underwent radical posterolateral thoracotomy for esophageal cancer, 33 cases underwent right lateral thoracic incision, mid-abdominal incision surgery (Ivorlewis procedure), 17 cases underwent cervical, thoracic and abdominal incision operation, and postoperative intravenous controlled analgesia PCIA), anti-infective, spasm phlegm, maintain airway patency, nutritional support and oxygen therapy; some patients to be respiratory support. Results Among the 76 cases, 19 cases were treated with mechanical ventilation after operation. There were 9 cases of pulmonary complications, 5 cases of cardiac arrhythmia and 1 case of neck anastomosis. No perioperative death was found, and all patients were cured . All patients were followed up for 3 to 6 months, all of whom recovered well without any operative complications. Conclusions Rigorous perioperative management and lung protection are important factors in the successful operation of esophageal cancer patients with pulmonary insufficiency.